- With only 13 months remaining, over 73pc components of $1b WB project await implementation
by MONEM FAROOQI
Punjab government has been sluggish in the implementation of $1.1165 billion Health Sector Reforms Project approved in 2013 by World Bank (WB) as only 27 percent of project components could be carried out till date.
In the WB project that is nearing its closure, according to documents available with Pakistan Today, only five of fifteen Disbursement Linked Indicators (DLIs) could be achieved to date.
Project Development Objective Indicators (PDOIs) clearly illustrate that Punjab government remained persistently apathetic, after coming into power in 2013, and did not work on any aspects which could lead to an increase in percentage of users satisfied with Punjab government’s health care services.
The government did not even increase the budget allocation, let alone use the budge already allocated for the project, the WB document adds.
The documents clearly mentions the high risks involved in implementing the project including unpardonable political influence and governance, lack of sector strategies and policies, inability of institutional capacity for Implementation and sustainability.
Besides, the documents specify, substantial and frequent changes in the Health Department management also severely affected the overall progress of the program during the project implementation. “There has been also a series of changes in the strategic direction of the Health Sector Strategy after its approval in 2013,” the documents mentioned.
Only 27 percent of the targets have been achieved in four components of Health Service Delivery worth $28.34 million, enhancing efficiency and effectiveness of the Health System worth $44 million, strengthening provincial Health Department capacity worth $22.26 million and fourth component costing $26.5 million for improving the capacities in technical areas for Equitable Health Services for all.
Regarding the implementation, the document reads,”the project had a very slow start with changes in the senior management of the department”. However, last year, the documents stated that the pace of implementation had improved a little as the Health Department resolved its pending issues, which led to the achievements of five out of fifteen Disbursement Linked Indicators (DLIs), resulting in 27 percent of the IDA credit being disbursed.
However, the documents referred “considering the project is already moving through its implementation, it is still far behind the original schedule.”
Highlighting the WB’s apprehensions, the documents mention, “There has been also a series of changes in the strategic direction of the health sector strategy after its approval in 2013. The bank’s follow-up mission in January 2016 found that a number of recommendations identified and agreed during the MTR were still pending mainly due to contextual changes since MTR, including the bifurcation of Health Department and changes in senior management.”
However, only upward movement had been witnessed in contraceptive prevalence rate, which touched its peak and achieved 100 percent target for provision of products and services to family planning clients.
Number of RHCs providing 24/7 basic EmONC services had been increased significantly on monthly average basis. In addition, proportion of children with SAM registered for treatment at stabilization centres in target districts, percentage of pregnant women registered with LHWs receiving IFA tablets during the last pregnancy, DUs reached by the program who reported using a new syringe at their last injection, monthly average number of OPD visits in BHUs and RHCs and percentage of districts with their respective BHUs providing all essential drugs were also increased.
Highly-placed Health Department sources told Pakistan Today that development objective of the proposed project was to support the implementation of the Punjab Health Sector Strategy by focusing on the improvement of the coverage and utilization of quality essential health services, particularly in the low performing districts of Punjab.
The project was to focus on building the capacity and systems to strengthen accountability and stewardship in Health Department. Sources said the bank’s follow-up mission in January 2016 found that a number of recommendations identified and agreed during the MTR were still pending.